Prostate Biopsies Can Be Omitted in Most Patients with a Positive Stockholm3 Test and Negative Prostate Magnetic Resonance Imaging

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2024-05-01 DOI:10.1016/j.euf.2023.08.009

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引用次数: 0

Abstract

Background

Magnetic resonance imaging (MRI) combined with the Stockholm3 test can be used to inform biopsy decision-making in patients with a suspicion of prostate cancer.

Objective

To determine the consequence of omitting biopsies in men with a positive Stockholm3 test and a negative MRI.

Design, setting, and participants

In a real-life setting, 438 men with a positive Stockholm3 test and a negative MRI underwent systematic biopsies from 2017 to 2020.

Outcome measurements and statistical analysis

The Stockholm3 test result is a percentage risk score with or without a prostate volume cutoff. The main outcomes were the number of clinically significant (Gleason grade group [GG] ≥2) and nonsignificant (GG 1) prostate cancers.

Results and limitations

Median prostate-specific antigen was 4.5 ng/ml (interquartile range 2.8–6.4 ng/ml) and the median age was 69 yr. Systematic biopsies detected grade group (GG) ≥2 disease in 48 men (11%, 95% confidence interval [CI] 8.4–14.2%) and GG 1 disease in 94 men (21.5%, 95% CI 17.9–25.6%). Of 256 patients without a volume cutoff in the test report, GG ≥2 was detected in 37 men (14.5%, 95% CI 10.7–19.3%). Omitting biopsies in patients with a volume cutoff would miss 11 GG ≥2 cases (6%, 95% CI 3.4–10.5%), reduce the number of GG 1 cases detected by 37 (39.4%, 95% CI 30.1–49.5%), and avoid a total of 182 biopsies (41.6%, 95% CI 37.0–46.2%). Limitations include the lack of follow-up data.

Conclusions

Systematic biopsies can be omitted in patients with a positive Stockholm3 test and a negative MRI when there is a volume cutoff in the test report. With no volume cutoff, biopsies can be considered with shared decision-making.

Patient summary

When investigated on suspicion of prostate cancer with a positive Stockholm3 test and a negative MRI (magnetic resonance imaging), prostate biopsies are only necessary for a subgroup of patients. This can spare some men from undergoing biopsies and reduce the detection of clinically insignificant cancers.

查看原文本刊更多论文

Stockholm3检测呈阳性而前列腺磁共振成像呈阴性的大多数患者可以省略前列腺活检。

背景：磁共振成像（MRI）结合Stockholm3试验可用于为怀疑患有癌症的前列腺患者的活检决策提供信息。目的：确定Stockholm3检测呈阳性而MRI呈阴性的男性省略活检的后果。设计、设置和参与者：在现实生活中，2017年至2020年，438名Stockholm3检测呈阳性、MRI检测呈阴性的男性接受了系统活检。结果测量和统计分析：Stockholm3检测结果是有或没有前列腺体积截断的百分比风险评分。主要结果是临床显著（Gleason分级组[GG]≥2）和非显著（GG 1）前列腺癌的数量。结果和局限性：中位前列腺特异性抗原为4.5 ng/ml（四分位间距2.8-6.4 ng/ml），中位年龄为69岁。系统活检检测到48名男性中的GG≥2级疾病（11%，95%置信区间[CI]8.4-14.2%）和94名男性中GG 1级疾病（21.5%，95%可信区间17.9-25.6%），在37名男性中检测到GG≥2（14.5%，95%CI 10.7-19.3%）。在容量截止的患者中省略活检将遗漏11例GG≥1病例（6%，95%CI 3.4-10.5%），将检测到的GG 1病例数量减少37例（39.4%，95%CI 30.1-49.5%），并避免总共182例活检（41.6%，95%CI 37.0-46.2%）。局限性包括缺乏随访数据。结论：当Stockholm3检测呈阳性而MRI检测呈阴性时，当检测报告中存在体积截断时，可以省略系统活检。在没有容量限制的情况下，可以考虑在共同决策的情况下进行活检。患者总结：当在Stockholm3检测呈阳性和MRI（磁共振成像）呈阴性的情况下对怀疑患有前列腺癌症的患者进行调查时，仅需对一组患者进行前列腺活检。这可以使一些男性免于接受活检，并减少临床上不重要癌症的检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.